Eye movement control by the cerebral cortex
Charles Pierrot-Deseillignya, Dan Mileab and René M. Müric
Purpose of review
This review focuses on eye movement control by the cerebral
cortex, mainly in humans. Data have emerged based on the
important contribution of recent techniques such as transcranial
magnetic stimulation and functional magnetic resonance
imaging, which provide complementary results to those of the
classical lesion and electrical stimulation studies.
Recent findings
The location of the human frontal eye field and its role in pursuit
eye movement control were recently detailed. Cumulative
evidence for the role of the dorsolateral prefrontal cortex in
unwanted reflexive saccade inhibition, short-term spatial
memory and prediction suggests that this area controls
decisional processes governing ocular motor behaviour. The
organization of spatial memory in the dorsolateral prefrontal
cortex (short-term), the parahippocampal cortex (medium-term)
and the hippocampal formation (long-term) is also reviewed with
the results of recent transcranial magnetic stimulation studies.
The relatively complicated anatomy of the posterior parietal
cortex in humans is briefly described followed by some
additional results concerning the location of the parietal eye field
– within the posterior half of the intraparietal sulcus – and its role
in visuo-spatial integration and attention. The other areas
involved in spatial attention are also examined in the light of
several recent contributing reports. Lastly, there are also new
functional magnetic resonance imaging findings concerning the
posterior cingulate cortex, which appears to be mainly involved
in the control of externally guided eye movements and
attentional mechanisms.
Summary
Many new findings on the organization of saccades and pursuit
eye movements at the cortical level have recently been reported.
Furthermore, eye movements are increasingly used as a tool to
elucidate relatively complex neuropsychological processes such
as attention, spatial memory, motivation and decisional
processes, and a considerable number of reports dealing with
these questions have been observed.
Keywords
attention, cingulate cortex, eye movements, frontal eye field,
parietal eye field, spatial memory
#
Curr Opin Neurol 17:17–25. 2004 Lippincott Williams & Wilkins.
a
INSERM 289 and Neurology Department 1, bDepartment of Ophthalmology,
Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France and
c
Perception and Eye Movement Laboratory and Departments of Neurology and
Clinical Research, University of Bern, Inselspital, Bern, Switzerland
Correspondence to Pr Ch Pierrot-Deseilligny, Service de Neurologie 1, Hôpital de la
Salpêtrière, 47 Bd de l’Hôpital, 75651 Paris Cedex 13, France
Tel: +33 1 42161828; fax: +33 1 44245247;
e-mail: cp.deseilligny@psl.ap-hop-paris.fr
Current Opinion in Neurology 2004, 17:17–25
DOI: 10.1097/01.wco.0000113942.12823.e0
Abbreviations
ACC anterior cingulate cortex
CEF cingulate eye field
DLPFC dorsolateral prefrontal cortex
FEF frontal eye field
fMRI functional magnetic resonance imaging
IPS intraparietal sulcus
PCC posterior cingulate cortex
PEF parietal eye field
PEM pursuit eye movement
PHC para-hippocampal cortex
PPC posterior parietal cortex
SEF supplementary eye field
SPL superior parietal lobule
TMS transcranial magnetic stimulation
# 2004 Lippincott Williams & Wilkins
1350-7540
Introduction
Eye movement research in humans has noticeably
advanced in recent years mainly thanks to new
investigative methods such as transcranial magnetic
stimulation (TMS) and functional magnetic resonance
imaging (fMRI), with currently a considerable increase
in the number of published studies using the latter.
What are the advantages and disadvantages of these two
methods compared with the classical lesion and electrical
stimulation studies? First, they can both be used in
normal subjects, who are clearly easier to explore than
patients with either small focal lesions or a pathology
warranting direct electrical stimulation of their cerebral
cortex. Secondly, they also provide clear advantages in
terms of spatial resolution for fMRI, which is in the order
of a few millimetres, and temporal resolution for TMS,
which is around a few milliseconds (Table 1) [1].
However, these new methods are unlikely to replace
completely the older methods in eye movement research
since lesion studies remain the best involvement
markers, determining which areas are crucial in the
control of a given paradigm [2]. In lesion studies, this
point may be inferred when a significant deficit is
observed after a small lesion of a cerebral area. By
contrast, fMRI studies are much less reliable in
establishing such a point, because activation may falsely
appear in certain areas or, above all, not be really crucial
to the execution of the paradigm. This problem is also
encountered in experimental electrophysiological stu-
dies, which also often require the use of muscimol in a
cerebral area (resulting in a temporary functional lesion)
in order to validate the crucial feature of an activity
observed in this area for the control of the studied
paradigm. TMS is not the best involvement marker
either, due to difficulty in controlling stimulation
intensity, which may be insufficient. Finally, in humans,
17
18 Neuro-ophthalmology and neuro-otology
Table 1. Effectiveness of methods currently used to study the functioning of human cerebral areas
Involvement marker: WHAT?
Lesion studies Good
Electrical stimulation studies Mild
Transcranial magnetic stimulation studies Mild
Functional MRI studies Mild
MRI, magnetic resonance imaging.
these different methods are really complementary to our
understanding of how the cerebral cortex controls a
paradigm. This complementation explains the recent
rapid advance in our knowledge of eye movement
organization, and even of the role of some neuropsycho-
logical processes in preparing the movement generally
when, for example, saccades are used as a tool or model
for motricity. This review will, therefore, mainly focus on
the latest advances in our knowledge of the control of
human eye movements at the cortical level. The roles of
some areas located in the frontal lobe, the parietal lobe
and the cingulate cortex will be reviewed, successively,
before a brief concluding overview of the main pathways
existing between them.
Frontal lobe
In the frontal lobe, three main areas are involved in eye
movement control [2]: the frontal eye field (FEF), the
supplementary eye field (SEF) and the dorsolateral
prefrontal cortex (DLPFC).
The frontal eye field
The FEF is involved in the preparation and triggering of
all intentional saccades, which are internally triggered
towards a target already present (intentional visually
guided saccade), not yet present (predictive saccade), no
longer visible (memory-guided saccade) or located in the
opposite direction (antisaccade) [2]. This area is less
involved in the triggering of reflexive visually guided
saccades (often called ‘pro-saccades’), which are exter-
nally triggered towards a suddenly appearing peripheral
target and are mainly dependent upon the parietal eye
field (PEF). The FEF also controls pursuit eye move-
ments (PEMs), along with the posterior parieto-temporal
areas. Recent findings on the FEF mainly concern its
location and its role in the control of PEMs.
Location
Studies using fMRI have delimited the location of the
FEF mainly to the intersection between the precentral
sulcus and the superior frontal sulcus (Fig. 1) [3]. Thanks
to a recent fRMI study [4], using 3-tesla, the saccade-
related area of the FEF has been localized to the upper
portion of the anterior wall of the precentral sulcus, and
the pursuit-related area to a deeper region along the
anterior wall, the fundus and the deep part of the
Spatial resolution: WHERE? Temporal resolution: WHEN?
Mild None
Mild Mild
Weak Good
Good Mild
posterior wall. This finding shows a high degree of
homology in the organization of the FEF in humans and
monkeys [5,6 .]. Furthermore, by using labelled tissue
sections in post-mortem human brains, it has been
shown that the area defined by fMRI studies within the
precentral sulcus may be classified by chemoarchitectur-
al criteria as a motor cortex, a result which was expected
considering the FEF’s functions in PEM control and
saccade triggering [7 .]. In the precentral sulcus, besides
the main locus of the FEF, located at the junction with
the superior frontal sulcus, another locus of activation is
often observed in fMRI studies along the lateral part of
this sulcus and the adjacent portion of the precentral
gyrus [8,9]. The specific role of this lateral locus remains
to be determined, since it is activated both by single and
combined eye and head movements [10 .].
Pursuit eye movements
Interestingly, in two electrical stimulation studies of the
human FEF, contralateral slow eye deviations were
observed [11 .,12 .]. Such slow eye deviations could
correspond to PEMs given their speed characteristics.
The stimulation sites of these slow eye deviations were
located in the precentral sulcus, more posterior than the
stimulation sites for saccades [12 .], a finding which is in
accordance with fMRI data [4]. However, it should be
noted that the human cerebral hemisphere, including
the FEF, controls mainly ipsilateral PEMs, even though
experimental data [5,6 .] and human lesion studies [13]
suggest that some degree of contralateral control by each
area also exists. To explain this apparent discrepancy
between this mainly ipsilateral hemispheric control of
PEMs and the results of electrical stimulation studies, it
may be assumed that stimulation, which was superficial
in the FEF region in these studies, in fact involved only
sites controlling contralateral PEMs. Indeed, such sites
could be located, as in the monkey [14], more super-
ficially than the ipsilateral PEM sites [12 .]. Like lesion
studies [13], fMRI studies suggest that the FEF also
controls optokinetic nystagmus [15], with an activation
existing in this area and in the other posterior hemi-
spheric cerebral areas involved in PEM, but also with
concomitant deactivation of the different cerebral areas
involved in the vestibular control [16 .]. Such results
could be due to a reciprocal inhibitory visuo-vestibular
interaction existing at the cortical level in order to
 Cerebral cortex eye movement control Pierrot-Deseilligny et al. 19

Figure 1. Main cortical areas and pathways involved in saccade control

Motor learning Intentional Motor Intentional Visual Attentional

motivation programmes saccade fixation motivation?
triggering

Decision: SEF
Pre-SEF Visuo-
Inhibition cs spatial
Prediction sfs post-cs
CEF attention?
Short-term
spatial memory FEF

DLPFC
pcs ips Visuo-
SPL spatial
PCC integration
SMG
ifs
SMG IPA
Visual
ls AG information
PEF ips
sts
+
AG
– pos

PHC +

HF

SC
RF Reflexive
Medium-term Long-term saccade
spatial memory? spatial memory? Execution triggering

SEF, supplementary eye field; sfs, superior frontal sulcus; CEF, cingulate eye field; cs, central sulcus; DLPFC, dorsolateral prefrontal cortex; pcs,
precentral sulcus; FEF, frontal eye field; ips, intraparietal sulcus; ifs, inferior frontal sulcus; SMG, supramarginal gyrus; PCC, posterior cingulate
cortex; SPL, superior parietal lobule; IPA, intraparietal areas; ls, lateral sulcus; AG, angular gyrus; PEF, posterior eye field; sts, superior temporal
sulcus; pos, parieto-occipital sulcus; PHC, parahippocampal cortex; HF, hippocampal formation; SC, superior colliculus; RF, reticular formations.

maintain the perception of self-motion. Finally, in the
monkey, it has been shown that the FEF neurons
controlling PEMs are also involved in vergence, a result
which suggests that PEMs are coded in three-dimen-
sional space by the frontal cortex [17 .].
Saccades
Antisaccades are intentional saccades which have to be
made in the direction opposite to a suddenly appearing
peripheral visual target. These saccades comprise two
different mechanisms [2]: (1) inhibition of an unwanted
reflexive misdirected saccade, triggered towards the
visible target by the PEF when such inhibition – being
under the control of the DLPFC (see below) – is no
longer efficient; the percentage of these misdirected
saccades (i.e. errors) reflects the inhibition function; and
(2) concomitant triggering of an intentional correct
antisaccade, made in the direction opposite to the target
by the FEF. Pro-saccades (reflexive visually guided
saccades) and antisaccades were studied using fMRI in
two reports [18 .,19 . .]. In both reports, activation was
observed just before antisaccades in the FEF but not in
the PEF, confirming that such intentional saccades
require an early preparation by the former but not by
the latter. However, contrary to a suggestion existing in
another recent fMRI study [20], this does not mean that
inhibition of misdirected reflexive pro-saccades is
organized in the FEF. In fact, an activation of the right
DLPFC was also noted just before antisaccades in one of
these fMRI studies [19 . .], in accordance with the results
of previous functional imaging studies [21,22]. Taken
together, these fMRI studies confirm the results of
lesion studies with specific damage to the DLPFC or the
FEF that had previously clearly shown that inhibition of
20 Neuro-ophthalmology and neuro-otology
misdirected reflexive pro-saccades depends upon the
former and the triggering of correct antisaccades upon
the latter (Fig. 1) [13,23,24 .]. The inhibition of reflexive
saccades by the DLPFC could be exerted directly on the
superior colliculus, without involving other cortical areas
[23], via a prefronto-collicular tract [25 .]. In addition, it
may be mentioned that an ipsilateral conjugate eye
deviation with paresis of voluntary contralateral gaze was
observed in a patient with a relatively small infarct
affecting the FEF region [26 .].
The supplementary eye field
The human SEF is located on the medial surface of the
superior frontal gyrus, in the upper part of the
paracentral sulcus (Fig. 1) [27]. The SEF is connected
with all areas involved in eye movement control – the
FEF, the DLPFC, the anterior cingulate cortex [28 .] –
and also the posterior parietal cortex. Lesion studies
have shown that the SEF is involved in motor
programmes comprising a saccade combined with a body
movement or a sequence of several successive saccades
[2]. In the case of a saccade sequence, TMS and fMRI
studies have also shown that a more anterior region (i.e.
the pre-SEF) is involved during the presentation of the
visual stimulation sequence (motor learning), whereas
the SEF proper is involved just before the execution of
the motor sequence [2]. In an electrophysiological study
in the monkey, using a saccade sequence, it was
confirmed that the SEF neurons are involved in the
coding of temporally ordered saccadic eye movements
[29 .]. In a recent TMS study, stimulation applied over
the SEF resulted in a disruption of the saccade order in a
double-step paradigm (comprising a sequence of two
successive saccades) [30]. This result may therefore also
have been due to the SEF control of saccade sequences.
Furthermore, it should be pointed out that in a recent
experimental study in the monkey, using an intentional
visually guided saccade task in which a single saccade
had to be performed, it was shown that a higher number
of SEF neurons were active than FEF and PEF neurons
and this activity was observed earlier [31]. Therefore, the
SEF could prepare all motor programmes early, even
when they are limited to a single saccade. This may also
explain the SEF activation observed in fMRI studies in
all single and sequence saccade paradigms [9], whatever
the nature of the single saccade to be performed. Thus,
this point illustrates how an area (i.e. the SEF) may be
active using fMRI without being in fact crucial to the
correct execution of a paradigm (e.g. a single memory-
guided saccade), as suggested by lesion and TMS
studies on the SEF [2].
The dorsolateral prefrontal cortex
The DLPFC is involved in saccade inhibition (see
above), but also in short-term spatial memory and in
decisional processes (Fig. 1) [2].
Spatial memory
The control of spatial memory in the human cerebral
cortex was recently reviewed [32]. The memory-guided
saccade paradigm is commonly used to study this
function with eye movements. In this paradigm, the
participant has to memorize the location of a target
flashed in the peripheral visual field while fixating a
central point, and then, after a delay of several seconds
or more, make a memory-guided saccade to the
remembered position of the flash. The amplitude of
this saccade may be considered as a reflection of spatial
memory. Lesion studies suggest that the DLPFC, and,
more particularly, area 46 of Brodmann and the adjacent
Brodmann area 9, both located in the middle frontal
gyrus, are involved in the control of memory-guided
saccades [24 .,33]. In a TMS study, it was stated that
DLPFC control of memory-guided saccades is exerted
during the delay period, when spatial memory is
involved [34]. FMRI studies have confirmed the
involvement of Brodmann area 46 in spatial memory
[35,36], with an activity in this area that can last at least
24 s [35]. In a psychophysical study in normal subjects, it
was suggested that a spatial memory system other than
that controlled by the DLPFC is involved for delays of
over 20–25 s [37]. A lesion study has led us to assume
that this other system, controlling medium-term spatial
memory, could involve the para-hippocampal cortex
(PHC) (Fig. 2) [38]. One of the questions raised by the
existence of these two successive systems controlling
spatial memory is that of whether their controls are
exerted in series (i.e. with a memorized coding in the
PHC completely built from the DLPFC information) or
in parallel (i.e. with the PHC coding built independently
of the DLPFC information).
In two recent complementary TMS studies in normal
participants, with stimulation of the DLPFC during
either a short delay (3 s) or a long delay (30 s),
abnormalities in the amplitude of memory-guided
saccades were observed. These results suggest (1) a
control of spatial memory by the DLPFC during the first
seconds of the delay; and (2) a partial independence
from the DLPFC state existing during these first
seconds for the building of memorized information used
in long delays [39 .,40]. This confirms that, in long delays
(30 s), medium-term spatial memory is controlled by
another structure (probably the PHC), in which, how-
ever, memorized information could be built from both
the DLPFC and another structure, probably the poster-
ior parietal cortex (PPC). These results therefore suggest
that the control of spatial memory by the DLPFC and
then the PHC is exerted both serially between them, via
the prefronto-temporal connections, and in parallel from
the PPC, which is also connected with these two areas
(Fig. 2). Finally, there is indirect evidence that long-term
spatial memory (involved after a delay of a few minutes)

Figure 2. Hypothetical and schematic cortical control of spatial memory
T, target; PPC, posterior parietal cortex;
DLPFC, dorsolateral prefrontal cortex; PHC,
parahippocampal cortex; HF, hippocampal
formation. a Time values are approximate.
Accuracy
is controlled by the hippocampal formation [32], but
further studies are needed to confirm this. To conclude
this review on the study of spatial memory using
memory-guided saccades, it should be pointed out that
this is a good example of how eye movements may be
studied not simply per se but also used as a tool in
neuropsychological or neuroscience research.
Decision
The DLPFC is also involved in the control of predictive
saccades. In this paradigm, a visual target moves to
locations and at times that are entirely predictable.
Normal subjects soon start to make predictive saccades,
anticipating the location to which the target is moving.
After lesions limited to the DLPFC, the percentage of
predictive saccades significantly decreases [24 .]. These
results in conjunction with those referred to above
suggest that the DLPFC plays a crucial role in decisional
processes governing eye movement behaviour, preparing
intentional saccades by inhibiting unwanted reflexive
saccades (inhibition), maintaining memorized informa-
tion for forthcoming intentional saccades (short-term
spatial memorization) or facilitating intentional anticipa-
tory saccades (prediction), depending upon current
external environmental and internal circumstances
[24 .]. In support of this decisional role, it may be
mentioned that in an fMRI study in normal subjects,
self-selecting the direction of the forthcoming saccade,
the DLPFC was strongly activated during the selection
period (Milea et al., in preparation). This decisional role,
which is important in guiding or inhibiting future
Cerebral cortex eye movement control Pierrot-Deseilligny et al. 21
Serial control Control in parallel
T PPC DLPFC PHC HF
300 ms 25 s 5mn
Visuo-spatial Short-term Medium-term Long-term
integration
Timea
responses, could be exerted through inhibitory interac-
tions between neurons in the DLPFC, controlling the
timing of neuronal activities during cognitive operations
and thereby shaping the temporal flow of information
[41].
Parietal lobe
In the parietal lobe, the location and function of the
different areas involved in eye movements and attention
are not well known.
Anatomy
The parietal lobe and more particularly its posterior part,
the PPC, are involved in the control of saccades and
attention. The PPC includes the intraparietal sulcus
(IPS) extending from the post-central sulcus anteriorly to
the parieto-occipital sulcus posteriorly (Fig. 1). The IPS
is slightly oblique along the antero-posterior axis, and so
is more lateral anteriorly and more medial posteriorly.
The IPS, which is a deep sulcus, separates the superior
parietal lobule (SPL) located medially (i.e. Brodmann
area 7) from the inferior parietal lobule, located laterally.
The latter comprises Brodmann area 40 (i.e. the
supramarginal gyrus), lying anteriorly around the ex-
tremity of the lateral sulcus, and Brodmann area 39 (i.e.
the angular gyrus), lying posteriorly around the extremity
of the superior temporal sulcus (Fig. 1). Thus, the
anatomy of the IPS is not simple, being relatively
variable from one subject to another. Furthermore, in
fMRI studies, it is difficult to differentiate activation
related to saccades from that related to attention,
22 Neuro-ophthalmology and neuro-otology
because a saccade always includes a shift of attention and
a pure shift of visual attention usually activates saccade
areas (e.g. the FEF) [2]. Consequently, the precise
locations within the PPC of regions specifically control-
ling saccades or attention remain relatively uncertain.
The parietal eye field and attentional areas
The human PEF corresponds to the lateral intraparietal
area of the monkey. The lateral intraparietal area is
involved in the control of saccades [42], but also in
attentional processes [43 .,44 . .]. Furthermore, light
stimulation of this area in the monkey results in a
simple shift of visual attention (without eye movement),
whereas stronger stimulation results in a saccade [45 .].
These results emphasize the close links existing
between saccades and attention, even in the same area.
The PEF appears to be located along the IPS [46],
within the sulcus, and, more precisely, after comparing
the results of several more recent fMRI studies on
saccades or visual attention [47–50,51 .,52 . .], in its
posterior half, adjacent laterally to the anterior part of
the angular gyrus (Brodmann area 39) and medially to
the posterior part of the SPL (Brodmann area 7). In this
posterior IPS area and on the basis of the results of an
fMRI study, using 4-tesla, the PEF could be located
mainly in the medial wall of the IPS [53 .]. The
activation of the PEF is also modulated by head position
[51 .], a result which is probably related to the role of this
area in visuo-spatial integration. Concerning this func-
tion, a recent TMS study [54] showed that the extra-
retinal signals required to determine the amplitude of
the second saccade in the double-step paradigm reach
the PPC, probably via the efferent-copy pathways, only
100 ms before the triggering of this saccade [54]. FMRI
studies [53 .,55 .] have also shown that a spatial updating
of visual information occurs in the human PPC (includ-
ing the PEF region) after an eye movement.
There is now accumulative evidence, on the basis of
fMRI studies, to suggest that the anterior part of the IPS
(limited medially by the supramarginal gyrus, i.e.
Brodmann area 40) is more involved in eye–hand
coordination [47,49,56], and the posterior part of the
SPL (close to the adjacent PEF) in attentional processes
[48,49,52 . .,56,57 .]. Furthermore, the supramarginal
gyrus (Brodmann area 40), during saccades [58] or purely
attention paradigms [48,49,57 .,59], and the angular gyrus
(Brodmann area 39), during reflexive saccades [60 .],
have more rarely been activated in fMRI studies.
However, this also suggests a control of these areas in
attention. These results may be related to the well-
known visual neglect syndrome due to right PPC lesions
affecting more particularly the angular gyrus [61].
The PEF projects to both the FEF and the superior
colliculus (Fig. 1). In the monkey, these two projec-
tions appear to be qualitatively different, with a more
visual involvement for the parieto-FEF projection and
a more saccadic involvement for the parieto-superior
colliculus projection [62]. The parieto-FEF projection
could be mainly involved in visual fixation [13]. The
results of a study in patients with lesions affecting the
posterior part of the internal capsule [63 .], damaging
the direct parieto-collicular tract originating in the
PEF, are in accordance with experimental results and
confirm that the PEF is crucial for reflexive saccade
generation [23] but not for intentional saccade genera-
tion. The latter depends mainly upon FEF control
(see above).
Cingulate cortex
The cingulate cortex is divided into the anterior
cingulate cortex (ACC) (Brodmann area 24) and the
posterior cingulate cortex (PCC) (Brodmann area 23).
The posterior part of the ACC is involved in saccade
control [64], more precisely in intentional saccade
control, but not in reflexive saccade control [65]. This
‘cingulate eye field’ (CEF), located at the limit between
Brodmann areas 23 and 24, could, via an intentional
motivation process, prepare all the frontal ocular motor
areas involved in intentional saccade control to act in the
forthcoming motor behaviour. The DLPFC is also under
the control of the CEF, as suggested – after CEF lesions
– by memory-guided saccade abnormalities [65] and by
saccade inhibition impairment in the antisaccade para-
digm [66 .].
The role of the PCC is less well known, because in the
monkey this area is influenced by saccade activity, but
with a discharge occurring only after the saccade onset
[67]. An fMRI study has shown that the PCC is active
during reflexive saccades but not during intentional
saccades [60 .]. Thus, the PCC appears to be the
equivalent, for reflexive saccade control, of the CEF
(within the ACC) for intentional saccade control,
namely by preparing the PEF to possibly act with a
reflexive saccade when attentional processes become
predominant. The PCC is also activated during PEM
[68,69 .]. Therefore, from an ocular motor point of view,
the CEF (ACC) could prepare the forthcoming
intentional eye movements, which are internally
governed, whereas the PCC could control the other,
externally-triggered eye movements: the reflexive
saccades and smooth pursuit. PCC activity also appears
to be related to attentional processes, though its precise
role in this field is still unclear. Two fMRI studies,
however, have suggested that the PCC is activated in
purely attentional paradigms as soon as an informative
cue indicates an imminent shift of visual attention
[70,71 .]. The PCC is connected to the IPS [71 .], but
further studies are needed to determine the precise
role of this pathway.
 Cerebral cortex eye movement control Pierrot-Deseilligny et al.
Conclusion
Figure 1 summarizes some of the cortical pathways and
mechanisms involved in saccade control. Visual informa-
tion originating in the occipital lobe becomes salient in
the parietal lobe thanks to diverse attentional areas
located in the posterior part of the SPL, the posterior
part of the IPS, including the PEF, perhaps other
intraparietal areas and probably also the IPL (supramar-
ginal gyrus or angular gyrus). However, the specific roles
of these different areas in attention control remain to be
determined. These areas probably interact and inter-
connect with the PCC, influencing them upstream via
an attentional motivation process. The PEF or a closed
area also controls visuo-spatial integration. A reflexive
saccade is triggered by the PEF if external circum-
stances require such a rapid response. This triggering is
performed via the direct parieto-collicular tract passing
through the posterior part of the internal capsule. In the
event of a delayed response, visual information is
transmitted from the PEF to the FEF for active fixation
and from the intraparietal areas to the DLPFC for short-
term spatial memorization (between 300 ms and 25 s).
The DLPFC is involved in decisional processes
governing ocular motor behaviour by inhibiting un-
wanted reflexive saccades (inhibition) controlled by the
PEF or facilitating the triggering of anticipatory saccades
(prediction) by the FEF. The inhibition of reflexive
saccades originating in the DLPFC is probably exerted
directly on the superior colliculus. When the response
delays are longer, the PHC for medium-term spatial
memory (between 25 s and a few minutes) and the
hippocampal formation for long-term spatial memory
(after a few minutes) store memorized information,
reaching the medial temporal areas probably both
serially from the DLPFC and in parallel from the
PPC. The execution of intentional saccades is per-
formed by the FEF, which is prepared to respond by
the CEF (located in the ACC) influencing, via an
intentional motivation process, all other frontal ocular
motor areas. When motor programmes, comprising either
a sequence of several successive saccades or single
saccades combined with body movements, are planned,
this involves the SEF just before the execution, after a
probable learning in the pre-SEF. PEMs are controlled
by the posterior hemispheric areas (not shown), located
close to the angular gyrus at the temporo-parieto-
occipital junction (medial superior temporal area and
middle temporal area), but also by the FEF, the specific
role of which in PEM generation is not yet really clear.
Finally, the recent period has been rich in new
information and interpretations concerning the cortical
control of eye movements in humans, thanks to some
lesion studies and especially to TMS and fMRI studies,
which are currently in full development and can be
expected to produce significant new advances in the
near future.
23
References and recommended reading
Papers of particular interest, published within the annual period of review, have
been highlighted as:
. of special interest
.. of outstanding interest
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24 Neuro-ophthalmology and neuro-otology
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25
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